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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPER^+TY AND/OR FACILITY <br /> LOCATED AT l,S O 1 1W° ®htx3a <br /> (S rest A cess) 7—� (City) <br /> HEREBY AUTHORIZE ' 6 <br /> ( o0") <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: s <br /> (If Applicable) <br /> OWNER/OPERATOR: m. <br /> (Please Print) (Title) <br /> w for Sfgnrtture) (Uat� <br /> ADDRESS: 11Q6 i' Yt7t1n1t, t of;_&T (.eC `lE,^ <br /> (Mailing Address) <br /> (City) (State) (Zip Cade) <br /> PHONE: (_ of —9_4 Q_ <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />